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FOR OFFICE USE: r-p.-10=7' ------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. . �, ---------- -- ------------------------ ----- -- (Complete-in Duplicate) . ......---------------- --------- - -_ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. F H,+9 . 076 L/8 �NT �7JOB ADDRESS AND LOCATIOh R Owner's Name------------------ 60 --- ---- Phone----v----------------•-----------•--- Address----------------------� = rr�..... _Q. Q_ ............. ------------------------------------------------ Contractor's Name----LpR-f11_X------FUL 4E.F -------------------_------ ---- -------------------------------------------- -- Phone------ ------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [] Number of living units: ____ Number of bedrooms 3- Number of baths:Z= Lot size ----149 __.X._I ao------------------------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table C_2 ft ` y Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam 00ay Loam ❑ Clay ❑ Adobe ❑ Hardpan El V` Previous Application Made: (If yes,dote.........--------- No New Construction: Yes-93---No ElFHA/VA: Yes ®� El "V TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from nearest well-.0-_...Distance from foundation------10...... Materi I __0A(C.i_7�----------- pko , Sixe x 1 Liquid depth---- � Capacity---l------- No. of com artments._.__Z--_.__...._ � � k- // � - �Q0---- Disposal Field: Distance from nearest well._CV!�_.-Distance from foundation---.l0...._._..Distance to nearest lot line-__-5 -----_-_ - ►� Number of lines----------- Length of each line__ . ._t_ ' 'Width of trench-------- �ei:___ Type of filter material.-ROCK----"Depth of filter material-----157--'"----- Total length---------2767--------------------- m Seepage Pit: Distance to nearest-well------------------- --Distance from foundation------------.-------Distance to nearest lot line----------------- ❑ Number of pits--- ----------------"-Lining rnate.nal------.---- .Size: Diameter------------x. ------Depth_-_--.------------------------- Cesspool: Distance from nearest welt ----------------Distancle—+6m,foundation................. ..Lining material---------..__.-.-_-_.--.-----.._-----. ❑ Size: Diameter- -- - --- -------- --------- ------Depth �` �.� --------------Liquid Capacity- - ------------------gals. Privy: Distance from nearest well------------------------------.---------------- _Disfance frc,m,,.neares+-buiIdin ❑ Distance to nearest lot line -_ ------------�" Remodelingand/or repairing (describe)----------------------- -- ------- - ------------------------------------------------------ -------------------------------------------------------- f ___------------------------------------------------------------------------------------------------------------------------------------_----_----_._.-__----.___.___.-...__._-____._-----_-_-._..----..._____._._-_______--.- ---------`-------------------------------------------•------------------------------------------------------------------------------ ---------------------------------------------------------.------.-_-__................ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. -�--i4--(-Signed)_- - = ------- ------ - ------ --. -_--••--- ------------- �..:�d - (Owner and/or Contractor) Y�- B --- ----------------------------------- --- -- ------ -- -----(Title)----�- - -- ------ - (Piot plan, showin ize of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR D OARTMENT USE ONLY APPLICATION ACCEPTED BY.--- FIR-o_------------------------ -------------------------------------- DATE------ .5` d r_6�--•----------------- REVIEWEDBY------ ---------- ----- ------------------- --------------------- --------------------------------------------- DATE-------------------------------------------- BUILDING PERMIT ISSUED-------- - --- ---- ------ DATE--------------------------------- - ------ Alterations and/or recommendations---------------- -.-- - ------- -- -----------m----------------------------------------------------- ----------------------------------------------------- ------------ -------- -------- ------ -------------------- --------- --------------------------- - -------- ----------- ----------------- ----- FINAL INSPECTI -- ---- ---- �- Date----------------�'_ ."_-117 .. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoxolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy, California E.H.9 2M 1-67 Vanguard Press tr=;